2023 Global Health Engagement and Humanitarian Surgery Presentations

Emad Madha, MD1; Michael Baird, MD1; John Whitaker, PhD, FRCS2; Matthew Arnaouti, MBBS3; Aldo Ayvar-Fuentes, MD, MSc, FACS4; Ghassan Alswaiti, MBBS5; Amila Ratnayake, MBBS, MS6; Tamara Worlton, MD, FACS1; Michelle Joseph, MBBS, BScHons, MSc, PhD, FRCS7; 1Walter Reed National Military Medical Center; 2Health Education West Midlands and Defence Deanery; 3The Royal London Hospital, Barts Health NHS Trust; 4Universidad Peruana de Ciencias Aplicadas; 5Royal Rehabilitation Center, Jordanian Royal Medical Services; 6Army Hospital Colombo; 7Program in Global Surgery and Social Change, Harvard Medical School

Objectives: Trauma is a leading cause of morbidity and mortality worldwide. Trauma systems development across pre-hospital, intra-hospital, and post-hospital phases improve patient outcomes. Military-Civilian Partnerships (MCP) can be mutually beneficial in trauma care delivery and advancement. The American College of Surgeons published guidelines for developing MCPs, specific to the US healthcare system and thus not directly generalizable, even to other High-Income Countries (HICs). The role and application of similar MCPs to support developing comprehensive trauma care in other settings, including Low- and Middle-Income Countries (LMICs), is unclear. The literature was reviewed to identify global examples of MCPs for trauma care delivery, and to determine emerging themes to inform an international framework. 

Methods: A scoping review of databases (MEDLINE, EMBASE, CINAHL, Web of Science, and unpublished studies and gray literature identified on Google Scholar) was performed to identify English-language papers describing military and civilian trauma systems integration. Two reviewers screened articles at multiple stages. After manuscripts were selected for inclusion, articles were analyzed to delineate whether the response was related to disaster or armed conflict, relevant data was extracted and coded into themes, and the level of integration was assessed. Author affiliations and study locations were classified by current World Bank income group.  

Results: 8173 studies were initially screened, with 74 studies meeting inclusion criteria. Authors were from 18 different?nations, describing experiences in 22 nations. Authors exclusively from HIC institutions wrote 68 (91.9%) publications. Experience based solely in HICs took place in 56 (75.7%) publications, describing varying integration and themes of skills sustainment, academic integration, geography, event-based integration, and high-level government support. Regarding levels of integration, there was coordination (12, 16.2%), collaboration with formal agreements (37, 50%), partial integration (18, 24.3%), and full integration (7, 9.5%). Of the 18 (24.3%) studies describing experiences in LMICs, 17 (94.4%) described MCP integration occurring only in response to an event (14 following disaster, two in conflict, and one during both conflict and disaster). The one that did not involve an event described Swedish surgeons travelling to South Africa for skills sustainment. Only six of 18 (33.3%) papers describing experiences in LMICs included authors from that setting.    

Conclusion: Based on available literature, MCPs largely occur in HICs where these partnerships can benefit both sectors. Examples identified in LMICs are limited to event-based partnerships. Further prospective investigation into MCPs in LMICs is needed to identify factors supporting successful integration in those settings.